NPIMap

Organization Active NPI

Dameron Hospital Association

  • Primary Care Clinic/Center
  • Stockton, CA
National Provider Identifier
1699195115
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
DAMERON HOSPITAL ASSOCIATION
Practice address
530 W Acacia St
Suite 1
Stockton, CA 95203-2454
Phone
(209) 944-5410
Fax
(209) 944-5477
NPI assigned
Apr 23, 2014
Last updated
Apr 24, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
DAMERON HOSPITAL ASSOCIATIONIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Lorraine P. Auerbach
Title
President & Ceo
Phone
(209) 461-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

530 W Acacia St
Suite 1
Stockton, CA 95203-2454

Mailing address

525 W. Acacia Street
Attn: Finance Department
Stockton, CA 95203-2484
Phone (209) 461-3148

Other identifiers 1

IdentifierTypeStateIssuer
05-0122OtherMEDICARE ID-TYPE UNSPECIFIED

Other names 1

  • Ambulatory Care Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100823000961 CA Part A Provider - Hospital 0648333039 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stockton, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699195115. Details of each certification follow.

Hospital certification: CCN 050122

Legal name
DAMERON HOSPITAL ASSOCIATION
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 24, 2019
Beds
211 (194 certified)
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Dec 28, 1943 in CA
Enrollment address
525 W Acacia St
Stockton, CA 95203-2484
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Dameron HospitalCCN 050122 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1074279Dameron Hospital Association530 W Acacia St, Ste 3, Stockton, CA 95203AccreditationMay 4, 2028

National Provider Directory

National Provider Directory
Part of
Dameron Hospital Associ

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Daniel J Dixon Individual Corporate DirectorVice Chairman of the Board Nov 15, 2005
Kathleen Janssen Individual Corporate DirectorDirector Jan 1, 2020
Michael Hakeem Individual Corporate DirectorBoard Member Aug 24, 2016
American Advanced Management, Inc Organization, Modesto, CA Management services company Operational/Managerial Control Dec 2, 2024
William Trezza Individual Corporate OfficerChairman of the Board Nov 1, 2013
Sanjeev Kumar Individual W-2 Managing EmployeeCfo Mar 10, 2025

Practitioners & affiliated clinicians

Affiliated clinicians 161

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 161

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398297600000",
    "number": "1699195115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 W. ACACIA STREET",
            "address_2": "ATTN: FINANCE DEPARTMENT",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952032484",
            "telephone_number": "209-461-3148",
            "fax_number": "209-461-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 W ACACIA ST",
            "address_2": "SUITE 1",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952032454",
            "telephone_number": "209-944-5410",
            "fax_number": "209-944-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAMERON HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAMERON HOSPITAL ASSOCIATIONI",
        "enumeration_date": "2014-04-23",
        "last_updated": "2014-04-24",
        "status": "A",
        "authorized_official_last_name": "AUERBACH",
        "authorized_official_first_name": "LORRAINE",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "209-461-3100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "05-0122",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ambulatory Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.